Coding Update: Rhinology Michael J. Sillers, M.D., F.A.C.S Alabama Nasal and Sinus Center Clinical Professor The University of Alabama-Birmingham Birmingham, Alabama
Coding Update: Rhinology
Michael J. Sillers, M.D., F.A.C.S
Alabama Nasal and Sinus Center
Clinical Professor
The University of Alabama-Birmingham
Birmingham, Alabama
Coding Update: Rhinology
• Teaching Objectives
– Understand basic coding principles
– Recognize new codes available in 2011
– Learn to appropriately code for “new procedures”
Coding Update: Rhinology
• Coding 101 – Common Procedural Terminology (CPT) is owned
by AMA
– CMS assigns value (RVU’s) to codes for physician payment (MPFS) and facility/non-facility reimbursement
– 3rd party payers may adopt CMS values, usually with a multiplier • A code in the book does not guarantee payment by 3rd
party payers!
Coding Update: Rhinology
• Coding 101
– CPT codes have 3 components
• Physician work-what we do
• Practice expense-what it “costs”
• Malpractice (~3% of total)
– Site of service differential
• Hospital (OPPS)
• ASC
• Non-facility (“office”)
Coding Update: Rhinology
• New balloon dilation CPT codes-Medicare physician fee schedule (MPFS)
– Proposed rule published in Federal Register 7/10
– Final rule published 11/10
– Rates/policies effective 1/1/11
Coding Update: Rhinology
• 31295-Nasal/sinus endoscopy, with balloon dilation of the maxillary sinus ostium
• 31296-Nasal/sinus endoscopy, with balloon dilation of the frontal sinus ostium
• 31297-Nasal/sinus endoscopy, with balloon dilation of the sphenoid sinus ostium
• *these codes are used when no tissue is removed-replace the 31299 code; when tissue removed, appropriate existing code is still used (31256,-76, -87)
Coding Update: Rhinology
• Codes are billable/payable • New codes carry “0” global days • Are subject to multiple procedure reduction-100,
50, 50, 50 (not 25%) • CMS has established Practice Expense (PE) RVU’s for
non-facility (office) payment • Additional work being done for facility
reimbursement-Ambulatory payment classification (APC’s); compensate for device-dependent procedures
Coding Update: Rhinology
• 61795-deleted as of January 1, 2011 – Subdivided into 3 codes
• 61781-stereotactic computer-assisted (navigation) procedures for the cranial, intradural region
• 61782-stereotactic computer-assisted (navigation) procedures for the cranial, extradural*
• 61783-stereotactic computer-assisted (navigation) procedures for the spinal region
• *61781 and 61782 should not be reported by the same provider in the same session (AMA 2011 CPT Changes: An Insider’s View)
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Coding Update: Rhinology
• 55 yom with medically refractory CRS without polyps
• Septoplasty, bilateral partial ethmoidectomy, bilateral maxillary antrostomy, left sphenoidotomy, ballon dilation of the left frontal sinus followed by formal frontal sinusotomy; surgical navigation employed
• How do you code?
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Coding Update: Rhinology
• 470 30520
• 473.2 31254-50
• 473.2 31276
• 473.3 31287
• 473.0 31256-50
• 61782
– balloon dilation of the frontal sinus was incident to the frontal sinusotomy (31276 vs.31296); cannot use 2 codes for same sinus
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Coding Update: Rhinology
• Patient returns 1 week post-op. Post-op course and pathology discussed, ethmoid cavities debrided, and treatment plan outlined. How do you code?
• 473.2 31237-50
• 473.3, 473.0, 473.1 99213-79,25
– Do not include 470 (deviated nasal septum); this may inadvertently kick this into global period for septoplasty
Coding for Endoscopic Skull Base Surgery
• 58 yo male with several month h/o progressive nasal obstruction, intermittent epistaxis, and headache.
• Examination reveals obstructing left nasal mass
• CT/MRI-5 cm soft tissue mass with destruction of CP and apparent dural but no brain parenchymal invasion.
• Biopsy shows ENB
Coding for Endoscopic Skull Base Surgery
• Endoscopic transnasal approach with complete spheno-ethmoidectomy, septectomy and MT resection. “3 hand technique” with 2 surgeons (ENT/Neuro)
• Cribriform plate resected on each side along with dural margin. Brain parenchymal margins are clear by frozen section
• Multilayered skull base reconstruction performed
Coding for Endoscopic Skull Base Surgery
• Modifiers
– -62 “Two surgeons”
– -52 “Reduced services” –appended to existing open codes
• Some advocate the use of this with the “approach” code
• Some will append modifier to all codes-approach, definitive and repair
• Least coding compliant
• Add-on codes
– 61781,-82 “Steroetactic computer-assisted volumetric (navigational ) procedure, intracranial, -extracranial
Coding for Endoscopic Skull Base Surgery
• *Unlisted Procedures
– Otolaryngologist submits 31299-”Unlisted procedure, accessory sinuses” –can append modifiers and add-on code (-62, 61782)
– Neurosurgeon submits 64999-“Unlisted procedure, nervous system”-can append modifiers and add-on code (-62, 61781)
– This is the most labor-intensive but also the most coding compliant
• Requires valuation of services
• Requires negotiation with payers
• May not get consistently reimbursed
– AAO-CPT committee actively pursuing endoscopic skull base codes in cooperation with Neurosurgery
• *coding recommendations compliments of Mary LeGrand with Karen Zupko and Associates